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Refreshed Insurance Workflows: Transitioning Your Insurance Appointments

We’ve refreshed Jane’s insurance workflows! 🥳

While working through these refreshments, you may have noticed that a few boxes and features have left Jane’s insurance billing altogether. Specifically, when working with an insured appointment, you’ll notice that Eligible Amount, Max Amount, Coinsurance as a $ amount, and Percent Coverage have been relieved of their duties in Jane’s US insurance billing arsenal.

These fields (along with a couple others) were initially borrowed from Canadian Insurance. However, with these workflow refreshments we’ve decided it is time to retire these Canadian fields in place of Allowed Amounts and Coinsurance %.

Using Allowed Amounts and Coinsurance % in place of Jane’s retired insurance fields

The list below covers how each of Jane’s retired insurance features can be substituted for Allowed Amounts and/or Coinsurance %

  1. Eligible Amount

    A claim’s Eligible Amount is essentially being directly substituted for individual billing code Allowed Amounts. When using the Eligible Amount box, you had to combine what the insurer allows for each code billed in a single claim. With Allowed Amounts, you can enter each billing code Allowed Amount separately and have Jane add them together for you (wohoo less math)! For example, if you bill two billing codes - one with an Allowed Amount of $30 and one with an Allowed Amount of $40 - you would add those individual respective amounts as billing code Allowed Amounts instead of adding a $70 lump Eligible Amount.

  2. Max Amount

    What is Max Amount anyways?

    Max Amount is a recycled Canadian Insurance concept! There is no direct substitute in this release - we’re just returning it to its rightful home North of the border.

    In the past, it was sometimes needed for Jane to balance invoicing after an EOB had been posted, but with our refreshed EOB screen it is no longer needed.

  3. Coinsurance $ Amount

    Now that Jane supports Coinsurance as a %, there is no need to keep Coinsurance as a $ amount.

    Just enter your patient’s Coinsurance % and Jane will calculate your patient’s responsibility based off of the billing code Allowed Amounts you’ve entered.

    For example, if you bill two billing codes - one with an Allowed Amount of $30 and one with an Allowed Amount of $40 - and enter a 20% Coinsurance, your patient’s bill will be $14 (20% of $30 + 20% of $40)

  4. Percentage Coverage

    Similar to Max Amount, Percentage Coverage is a recycled Canadian insurance concept that doesn’t quite fit south of the figurative insurance border.

    Now that Jane supports Coinsurance as a %, there’s no longer a need for this field!

  5. Insurer Specific Billing Codes

    If you’re not sure what Insurer Specific Billing Codes are, then no worries and no need to pay this section any more mind!

    Insurer Billing Codes - like Max Amount and Percentage Coverage - are Canadian insurance concepts that never truly fit the US insurance bill. In order to make room for billing code Allowed Amounts, we now require billing codes to be added above insurance policies. We call this workflow ‘Billing Codes First’. To learn more about adding Billing Codes First, please click here.

How do I manage appointments that are already using these retired insurance pieces?

If you need to edit a past or current appointment that is invoiced with one or more of these retired insurance features, then Jane will alert you as soon as you try to make a change to the visit invoicing (i.e. change the copay or add an additional billing code).

Simply follow the instructions to clear the retired fields in order to start using Allowed Amounts and Coinsurance as a %. It is a good idea to note down any retired legacy field values (i.e. Eligible Amount) for reference since once you update the claim, the retired fields as well as their values will be cleared.

Let’s walk through an example

Please note this is the same example covered in the video at the top of this guide 👆

Let’s say we’re billing out two billing codes - $150 and $50 - to our UHC insurer. We know that UHC will allow $100 for our first code and $40 for our second code. We also know that our client has a 20% Coinsurance.

In the past, you may have entered $140 as the claim Eligible Amount ($100 + $40). Likewise, you may have manually calculated the patient’s $28 Coinsurance (20 % of $140) outside of Jane and entered it into the Coinsurance as a $ amount field.

If the claim is ready to be billed as-is, then you aren’t required to make any changes. You can still produce a claim submission while Eligible Amount and Coinsurance as a $ amount are present!

However, if you want to make a change to the visit before submitting the claim (i.e. adding in an additional billing code or changing the patient invoicing), then Jane will require that you clear the retired fields before proceeding.

After making a change to the visit, Jane will highlight the retired legacy fields and display a button that when pressed transitions the visit to the refreshed insurance workflow. It is a good idea to note down any retired field values (in this example, the $140 Eligible Amount and $28 Coinsurance) for reference since once the claim is updated, the retired fields as well as their values will be cleared.

Once the claim is updated, you can enter in the individual billing code Allowed Amounts ($100 and $40) as well as the patient’s Coinsurance (20%).

That’s it! All that’s left to do is bill the claim. 🙂

If you have any questions about these retired fields or anything else related to our refreshed insurance workflows, we’d love to hear from you! Use the Help button from within your Jane account or email us at support@janeapp.com.